Current State of Classification and Staging of Bladder Cancer

Summary

The most important determinant for treatment as well as prognosis is the presence or absence of muscle invasion as determined by the histopathological material obtained by a properly performed biopsy. Histological grade of the tumor is also important inasmuch as high-grade tumors are usually always associated with invasion, whereas low-grade tumors are usually superficial. The presence or absence of carcinoma in situ is also an important histological feature and may be diagnosed with increasing accuracy by improved cytopathological techniques.

The TNM system, although useful in the accurate staging of definitive cystectomy specimens, offers little to clinical management. The inherent and significant problems of clinical staging and difficulties in attempting to correlate presenting pathology with correct management planning persist. What is needed, in my opinion, is simplification of clinical staging, elimination of stages that cannot be accurately determined by existing methods, and better identification of criteria for treatment planning.